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Ann Surg:减肥术后警惕餐后高胰岛素低血糖

2016-08-28 Moon 译 MedSci原创

Roux-en-Y胃旁路手术(RYGB)是一种改变肠道结构、关闭大部分胃功能的手术。手术将患者的胃分成上下两部分,用于容纳食物的只有原来胃部的1/6-1/10,然后在小胃的切口处开一条“岔路”,接上截取的一段小肠,重新排列小肠的位置,改变食物经过消化道的途径,减缓胃排空速度,缩短小肠,降低吸收,从而达到减肥的目的。 经常有RYGB术后餐后高胰岛素低血糖(PHH)的报道,但目前关于PHH的临床

Roux-en-Y胃旁路手术(RYGB)是一种改变肠道结构、关闭大部分胃功能的手术。手术将患者的胃分成上下两部分,用于容纳食物的只有原来胃部的1/6-1/10,然后在小胃的切口处开一条“岔路”,接上截取的一段小肠,重新排列小肠的位置,改变食物经过消化道的途径,减缓胃排空速度,缩短小肠,降低吸收,从而达到减肥的目的。

经常有RYGB术后餐后高胰岛素低血糖(PHH)的报道,但目前关于PHH的临床和生物学因素仍不清楚,且缺乏相关前瞻性研究。因此有研究者进行了研究,探究RYGB术后PHH的发生率和预测因素。

该研究纳入了957例RYGB患者,在术前、术后1年和/或5年常规进行口服葡萄糖耐量试验(OGTT)分析。PHH定义为:OGTT2小时后血糖<50 mg/dL+血浆胰岛素>3 mU/L。根据OGTT过程中测量的血糖、胰岛素和C肽等值对胰岛素敏感性(Matsuda指数)、β细胞功能(胰岛素分泌指数)和β细胞量(空腹C肽:血糖比)的验证指标进行计算。

基线、术后12个月和术后60个月可获取的患者OGTT数据分别为100%、85.6%和52.8%的患者;三个时间点的PHH发生率分别为0.5%、9.1%和7.9%(P < 0.001)。多因素Logistic回归分析显示,RYGB术后PHH风险与以下因素相关:更小的年龄(P = 0.005)、减重更多(P = 0.031)、更高的β细胞功能(P = 0.002)和更高的胰岛素敏感性(P < 0.001),不过与β细胞量无关(P = 0.381)。术前升高的β细胞功能是PHH的独立预测因子(ROC AUC 0.68, P = 0.04)。

结果表明,RYGB术后PHH发生率明显增加,但是在术后1年-5年的时间段里保持稳定。术前通过OGTT评估患者β细胞功能有利于识别患者RYGB术后PHH发生风险。

原始出处:

Raverdy V.et al. Incidence and Predictive Factors of Postprandial Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass: A Five year Longitudinal Study. Ann Surg. 2016 August 23.

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    2016-11-26 kksonne
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    2016-10-26 baoya
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    2016-09-23 1e10c84am36(暂无匿称)

    文章不错,继续学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1675632, encodeId=68ca16e5632ef, content=<a href='/topic/show?id=a678312e289' target=_blank style='color:#2F92EE;'>#减肥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31272, encryptionId=a678312e289, topicName=减肥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ee227270207, createdName=kksonne, createdTime=Sat Nov 26 13:53:00 CST 2016, time=2016-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749630, encodeId=91ef1e4963071, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7a536274692, createdName=baoya, createdTime=Wed Oct 26 23:53:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=133665, encodeId=d7e013366515, content=文章不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 23 16:19:00 CST 2016, time=2016-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131626, encodeId=e5ae1316260e, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:10:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=124134, encodeId=605b124134ac, content=学习学习。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ceb079804, createdName=lhl629, createdTime=Tue Sep 13 05:18:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=123912, encodeId=748812391258, content=有更多的原因分析就更好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Mon Sep 12 19:36:00 CST 2016, time=2016-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111229, encodeId=60c2111229ab, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 05 10:11:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=109880, encodeId=36e410988097, content=好,学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Sep 02 21:55:00 CST 2016, time=2016-09-02, status=1, ipAttribution=)]
    2016-09-20 1e10c84am36(暂无匿称)

    文章很好,非常有益

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1675632, encodeId=68ca16e5632ef, content=<a href='/topic/show?id=a678312e289' target=_blank style='color:#2F92EE;'>#减肥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31272, encryptionId=a678312e289, topicName=减肥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ee227270207, createdName=kksonne, createdTime=Sat Nov 26 13:53:00 CST 2016, time=2016-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749630, encodeId=91ef1e4963071, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7a536274692, createdName=baoya, createdTime=Wed Oct 26 23:53:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=133665, encodeId=d7e013366515, content=文章不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 23 16:19:00 CST 2016, time=2016-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131626, encodeId=e5ae1316260e, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:10:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=124134, encodeId=605b124134ac, content=学习学习。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ceb079804, createdName=lhl629, createdTime=Tue Sep 13 05:18:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=123912, encodeId=748812391258, content=有更多的原因分析就更好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Mon Sep 12 19:36:00 CST 2016, time=2016-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111229, encodeId=60c2111229ab, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 05 10:11:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=109880, encodeId=36e410988097, content=好,学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Sep 02 21:55:00 CST 2016, time=2016-09-02, status=1, ipAttribution=)]
    2016-09-13 lhl629

    学习学习。。。

    0

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    2016-09-12 舒心和人

    有更多的原因分析就更好了

    0

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    2016-09-05 李东泽

    很好,不错,以后会多学习

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1675632, encodeId=68ca16e5632ef, content=<a href='/topic/show?id=a678312e289' target=_blank style='color:#2F92EE;'>#减肥术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31272, encryptionId=a678312e289, topicName=减肥术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ee227270207, createdName=kksonne, createdTime=Sat Nov 26 13:53:00 CST 2016, time=2016-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749630, encodeId=91ef1e4963071, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7a536274692, createdName=baoya, createdTime=Wed Oct 26 23:53:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=133665, encodeId=d7e013366515, content=文章不错,继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 23 16:19:00 CST 2016, time=2016-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131626, encodeId=e5ae1316260e, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:10:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=124134, encodeId=605b124134ac, content=学习学习。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ceb079804, createdName=lhl629, createdTime=Tue Sep 13 05:18:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=123912, encodeId=748812391258, content=有更多的原因分析就更好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Mon Sep 12 19:36:00 CST 2016, time=2016-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111229, encodeId=60c2111229ab, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 05 10:11:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=109880, encodeId=36e410988097, content=好,学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Sep 02 21:55:00 CST 2016, time=2016-09-02, status=1, ipAttribution=)]
    2016-09-02 1771ae4158m

    好,学习一下

    0

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